D1216S Treatment Service Voucher for use by Specialists and Consultant Physicians only D1216S Treatm 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Patient Details section. Enter the patient’s file number, first name, initial, and surname. If the file number is unknown, include the date of birth and address.
3. In the Item Number or Description of Service field, write down the relevant service details.
4. Complete the ‘Condition Treated’ section only if applicable for White card holders or emergency services.
5. Fill in the 'Treatment Location' section if services are not conducted in rooms. Specify the hospital if applicable.
6. If pathology is requested, provide a brief description in the designated area.
7. Ensure that the patient signs where indicated. If they cannot sign, complete that section accordingly.
8. For emergency services, ensure to cross and sign the appropriate section.
9. Submit the Departmental copy along with any relevant documents with your claim and ensure that the patient receives their copy.

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